Advocacy & Compliance

Healthesystems’ Advocacy & Compliance experts are essential in the management of pharmacy and ancillary benefits for our clients. By tracking and influencing regulatory activity, our team stays ahead of evolving trends and identifies opportunities to advocate on behalf of our clients, their injured workers, and the broader industry.

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The Advocacy &  Compliance Team

Monitors and reports on proposed and pending regulatory changes that impact workers' comp, helping shape effective program strategies

Advocates for fair and balanced public policy through proactive engagement with regulators, customers, and other stakeholders throughout the rulemaking lifecycle

Supports operational compliance by providing guidance to internal stakeholders and external partners during the implementation of new regulatory changes

Regulatory Recap

A weekly e-newsletter informed by the Advocacy & Compliance team to help keep our clients and industry contacts in the know on the latest legislation and policy updates impacting workers’ comp.

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Mental Health Presumptions

Idaho Bill Would Expand the Definition of “First Responder” for PTSD Coverage

The new bill would add coroners, “medicolegal” death investigators, and qualifying coroner employees to the list of first responders eligible for workers’ compensation benefits for post-traumatic stress injuries.

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March 30, 2026

Cost Containment

Pennsylvania Proposes Price Caps on Compound and Topical Drugs

Senate Bill 1215 proposes a $400, 30-day supply cap for compound drugs and a $240, 30-day supply cap for non-compound topicals.

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March 23, 2026

Advocacy Opportunity Cost Containment

Florida Appeals Court Rules in Favor of Carriers and Employers on Physician-Dispensed Drugs

While injured workers have an absolute choice over their pharmacist, physicians are not considered pharmacists and therefore not entitled to reimbursement.

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March 2, 2026

Cost Containment Treatment Guidelines

Hawaii May Require Compounds to Be Created by Licensed, In-State Pharmacists

The state’s definition of “compounded prescription drug” would be updated to fall in line with federal standards.

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March 23, 2026

Marijuana

New Jersey Proposes Medical Marijuana Reimbursements in Workers’ Comp

Two new companion bills carryover similar marijuana reimbursement proposals from 2024.

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March 23, 2026

Billing & Payments Claims Procedures Cost Containment

Louisiana Reform Package Proposes Centralized Medical Authorization Database

Additionally, the bill would update the fee schedule and impact billing and utilization requirements.

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March 23, 2026

Billing & Payments Cost Containment

South Carolina Approves 2026 Fee Schedule and Targets IMEs

The updated fee schedule will go into effect April 1st, while a new IME subcommittee will evaluate cost and practice concerns.

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March 23, 2026

Technology

American Medical Association Reports on Increased Physician AI Use

Over 80% of physician respondents currently use AI in a professional context – double the share reported in 2023.

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March 23, 2026

Advocacy Opportunity Cost Containment

Massachusetts Announces Draft Fee Schedule Rules

At a March 11th meeting, the Workers’ Compensation Advisory Council announced a draft expected in fall of 2026 for public comments.

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March 16, 2026

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Further resources you may be interested in

Additional articles and updates from Healthesystems related to policy shaping workers’ comp.

Sleep Woes: Fatigue in the Workplace

Sleep deprivation and fatigue have far-reaching consequences in the workplace, from poor productivity to injury or death.

Expert Q&A: Cybersecurity Tactics in Workers’ Compensation

RxInformer editors sat down with Healthesystems’ AVP of Information Security and resident cybersecurity expert, Tony Brown, to discuss how cyber threats affect workers’ comp organizations.

Drug Pricing Legislation and Its Impact on Workers' Comp

Lawmakers look to regulate the U.S. drug supply chain in ways that could impact workers’ comp pharmacy management.

High Prices, High Impact: Meet the Drugs Driving Up Claim Costs in Workers’ Comp

High-impact drugs, including topicals and compounds, represent proportionately low utilization compared to opioids or NSAIDs, but they can increase pharmacy spend exponentially on impacted claims.